Sample request form

OMB Control No. 0648-xxxx

Expiration Date: xx/xx/xxxx

Deepwater Horizon Oil Spill – Sample Request Form

Requestor Information

Name:

Affiliation:

Address:

Email:

Phone:

1. Identify the types and quantities of samples of interest (i.e., specific matrices, species, areas, or dates collected).

2. For those requesting sea turtle or marine mammal samples: Provide the purpose and/or research plan including conservation benefit for use of these samples.

3. a) For those requesting sea turtle samples: Provide your existing or pending permit numbers including all permits necessary (federal and/or state) for possession and use of the requested samples.

b) For those requesting marine mammal samples: Provide proof of authorization to receive marine mammal parts under 50 CFR 216.22 or 216.37 (e.g., parts authorization letter, marine mammal permit, stranding agreement). If you are in the process of obtaining authorization, please provide the details.

c) For those requesting bird samples: Provide your existing or pending Migratory Bird Treaty Act permit or other required permits for possession and use of the requested samples.

4. Recipients may pick up samples at the current storage facility if a mutually agreeable arrangement can be made, or may arrange for shipping through a commercial shipper such as FedEx or UPS, using the recipient’s account information or a prepaid label. Shipping materials (coolers, packing materials) and special procedures for hazardous shipments may also be required. The recipient should expect to send an appropriate shipping container to the current storage facility for return with samples. Provide your preferred arrangement for taking possession of samples. If shipping, do you have the ability to pay shipping costs and provide shipping materials?

5. Provide the earliest date you are prepared to receive requested samples.

6. Do you have additional comments or requests?

Send inquiries and responses to [email protected].

Notice:

The United States, its agencies and instrumentalities shall not be responsible for claims of any kind (including loss during transport) regarding the samples provided pursuant to this request form. Sample disposal may be subject to Federal, State and local laws and regulations. Samples may also be hazardous substances subject to various legal requirements regarding transportation, handling, storage and disposal.

PRA Statement:

Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. No confidentiality is promised. Send comments regarding this burden estimate or any other suggestions for reducing this burden to Greg Baker, NOAA National Ocean Service, Office of Response and Restoration, [email protected].

Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.